Cante Domenico, Franco Pierfrancesco, Sciacero Piera, Girelli Giuseppe Franco, Casanova Borca Valeria, Pasquino Massimo, Tofani Santi, Bombaci Sebastiano, Migliaccio Fernanda, Marra Annamaria, Numico Gianmauro, La Porta Maria Rosa, Ricardi Umberto
Department of Radiation Oncology, ASL TO4, Ospedale Civile di Ivrea, Ivrea, Italy.
Tumori. 2013 Mar-Apr;99(2):e80-3. doi: 10.1177/030089161309900235.
Adult sarcomas of the head and neck region (HNSs) are considered a rare clinicopathological entity. They account for only 2-15% of all adult sarcomas and for less than 1% of all head and neck malignancies. The preferred initial treatment option is wide surgical excision. Whenever surgery is considered infeasible, a frontline combined-modality approach including radiotherapy and chemotherapy might be proposed. We here report on a case of localized sarcoma of the maxillary sinus treated with induction chemotherapy and subsequent intensity-modulated radiation therapy (IMRT), achieving a persistent complete remission status.
A 66-year-old man was referred to our institution hospital for left-sided facial pain with swollen left cheek and ipsilateral facial palsy. Magnetic resonance imaging showed a mass within the left maxillary sinus extending to the orbital floor and adjacent alveolar bones. Histological examination of the biopsy specimen demonstrated a myxofibrosarcoma. The patient underwent induction chemotherapy with gemcitabine 900 mg/m2 (days 1-8) and taxotere 80 mg/m2 every 3 weeks for 3 cycles and sequential simultaneous integrated boost (SIB) IMRT up to a total dose of 70 Gy/35 fractions to the macroscopic disease with 59.5 Gy/35 fractions to the level IB-II lymph nodes in the left neck.
Treatment was well tolerated with mild acute toxicity. Complete remission was achieved at restaging MRI 6 months after the end of the combined modality approach. The patient remains in complete, unmaintained clinical and instrumental complete remission 18 months after treatment, with no late side effects.
Combination therapy with induction chemotherapy and sequential SIB-IMRT could therefore be a promising modality for head and neck sarcomas, allowing for simultaneous tumor control and normal tissue sparing.
头颈部区域成人肉瘤（HNSs）被认为是一种罕见的临床病理实体。它们仅占所有成人肉瘤的2 - 15%，占所有头颈部恶性肿瘤的比例不到1%。首选的初始治疗方案是广泛手术切除。每当手术被认为不可行时，可能会提出包括放疗和化疗的一线综合治疗方法。我们在此报告一例上颌窦局限性肉瘤患者，经诱导化疗及随后的调强放射治疗（IMRT）后，达到持续完全缓解状态。
一名66岁男性因左侧面部疼痛、左侧脸颊肿胀及同侧面瘫被转诊至我院。磁共振成像显示左侧上颌窦内有一肿块，延伸至眶底及相邻牙槽骨。活检标本的组织学检查显示为黏液纤维肉瘤。患者接受诱导化疗，吉西他滨900 mg/m²（第1 - 8天），多西他赛80 mg/m²，每3周1次，共3个周期，随后进行序贯同步整合加量（SIB）IMRT，对肉眼可见病变的总剂量达70 Gy/35次，对左侧颈部IB - II级淋巴结的剂量为59.5 Gy/35次。
治疗耐受性良好，急性毒性轻微。综合治疗结束6个月后的分期MRI显示达到完全缓解。治疗后18个月，患者仍处于完全、无需维持的临床及影像学完全缓解状态，无晚期副作用。
因此，诱导化疗与序贯SIB - IMRT联合治疗可能是头颈部肉瘤的一种有前景的治疗方式，可同时实现肿瘤控制和保护正常组织。
